| Summary: | 碩士 === 國立臺灣大學 === 衛生政策與管理研究所 === 96 === With the rise of managed care, medical consumerism, and the corporatization of hospitals, medical professionalism has experienced drastic transition in the past few decades. Although the image of medical profession become more and more negative, as reflected in the media and illustrated by the accumulated criticism from sociologists, very few empirical research have been done to tap the perceptions and observations that come from the physicians themselves.
The purposes of this study, therefore, are to describe the physicians’ attitudes towards medical professionalism, i.e., their professional values, and then examine how the values they hold influence their assessment of current state of medical performance, and, if any deficiency in professionalism was indicated, for which what factors did they attribute the blame.
Data on which this study was based came from a nation-wide mail survey. Through a systematic sampling, about 8000 physicians who were practicing in biomedicine (so-called Western physicians) and having memberships in Taiwan Medical Association in the year 2007 were selected as potential participants for this study. Started in January 2008 and after one follow-up mailing, a total of 1679 valid questionnaires were collected in March 2008, resulting in a response rate of 21%.
The major findings of this study are: (1) The professional values held by this sample of physicians are presented in the following aspects of professionalism: 64.4% physicians did not agree that their clinical autonomy should be regulated by the National Health Insurance (NHI) even under the situation of limited health care resources; 67.1% said that the patients’ welfare will be their top priority even in face of NHI restrictions; about 80% emphasized that profit should not be taken into account while providing clinical services; and 52.5% supported the idea that patients should have more autonomy in the process of medical care decision making, (2) With regard to their assessment of current performance among their professional members, most of them made an overall positive assessment, although the aspects of listening, and informing and advising during patient-physician interactions were considered relatively unsatisfactory, and (3) In response to deficiency in professionalism or poorer professional performance, NHI, consumerism, and societal values were three blames most often attributed by the participants, and (4) Physicians who made justification on the restriction of clinical autonomy under stringent resources were more likely to attribute current poor performance to the managerialism adopted by hospitals, and (5) Physicians’ age (cohort) is the most powerful factor in relation to professional value and self-assessment of performance. The older the age the more strong the professional values they held, and more positive their assessment of current professional performance.
Contemporary physicians in Taiwan still hold conventional medical professionalism, and their assessment of current performance of their professional members is positive overall, with the communicative skill the poorest competency. Although NHI, as a national health policy, has exerted much impact on their practices in general, in particular managerial interventions applied in health care organizations are considered the ultimate menace to their professionalism. Yet beyond blaming, some physicians also argue that medical professionals must be responsible for the status quo because of the failure of self-regulation.
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